NPIMap

Individual provider Active NPI

Peter G Danis, MD

  • Family Medicine Physician
  • Creve Coeur, MO
National Provider Identifier
1669447314
Registry record updated Sep 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R4C19 Issued in MO
Practice address
12680 Olive Blvd
Suite 300
Creve Coeur, MO 63141-6322
Phone
(314) 251-8889
NPI assigned
Feb 17, 2006
Last updated
Sep 18, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R4C19 MO Primary

Addresses

Primary practice location

12680 Olive Blvd
Suite 300
Creve Coeur, MO 63141-6322

Mailing address

12680 Olive Blvd
Suite 300
Creve Coeur, MO 63141-6322
Phone (314) 251-8889

Other identifiers 2

IdentifierTypeStateIssuer
1669447314MedicaidMO
080192174OtherMORAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070531000271 MO Practitioner - Family Practice 5597863431 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Saint Louis University School of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic East CommunitiesGroup PAC ID 7214827922, 573 clinicians

Practice addresses (Care Compare)

12680 Olive Blvd
Suite 300
Saint Louis, MO 63141-6322
Phone (314) 251-6050

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions12

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
R4C19MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic East Communities Family Medicine CurrentSince Jul 1, 2007 Accepting new patients
Mercy Clinic East Communities Family Medicine CurrentSince Jul 1, 2007 Accepting new patients
Mercy Hospitals East Communities Family Medicine Past Accepting new patients

Locations

12680 Olive Blvd
Ste 300
Saint Louis, MO 63141
Phone (314) 251-8888

621 S New Ballas Rd
Ste 189A
Saint Louis, MO 63141
Phone (314) 251-6335

621 S New Ballas Rd
Ste 4017B
Saint Louis, MO 63141
Phone (314) 872-9192

Interoperability endpoints

  • Direct secure messaging: pdanis1163@directc.mercy.net

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410998400000",
    "number": "1669447314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12680 OLIVE BLVD",
            "address_2": "SUITE 300",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631416322",
            "telephone_number": "314-251-8889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12680 OLIVE BLVD",
            "address_2": "SUITE 300",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631416322",
            "telephone_number": "314-251-8889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANIS",
        "first_name": "PETER",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-17",
        "last_updated": "2014-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R4C19",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669447314",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080192174",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Creve Coeur, MO

Sources for this page

Verify at the official NPI Registry.